CPT 97161 Fee Schedule

Last Verified: July 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Pt Eval Low Complex 20 Min, Physical Therapy Evaluation Low Complexity Requiring These Components A History With No Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body System S Using Standardized Tests And Measures Addressing 1 2 Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Stable And Or Uncomplicated Characteristics And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 20 Minutes Are Spent Face To Face With The Patient And Or Family

Key Fact	Detail
Service Type	Physical Medicine and Rehabilitation Therapeutic Procedures Physical Medicine and Rehabilitation Evaluations
Common Place of Service	11 - Office None
Common Modifiers	None GP - Services delivered under an outpatient physical therapy plan of care 59 - Distinct Procedural Service
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 97161

National average reimbursement for CPT 97161 by major payers:

$99.32

$89.92

$91.01

$108.78

Preview provider-level rates for...

For billing codeCPT 97161

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	97161	$77.40	1992958979 - KEITH BRANDWEN	134074478 - (NY) UNION COMMUNITY HEALTH CENTER INC	NY	Occupational Therapist (225X00000X)
United	97161	$88.00	1760631444 - THOMAS LORENZO	135562308 - NEW YORK UNIVERSITY	NY	Physical Therapist (225100000X)
United	97161	$51.83	1043309925 - STEWART SCHWARTZ	1043309925 - (NY) STEWART SCHWARTZ	NY	Speech-Language Pathologist (235Z00000X)
United	97161	$79.62	1083869432 - ANNA MIRIELLO	205378306	NY	Speech-Language Pathologist (235Z00000X)
United	97161	$88.00	1467656496 - ALICIA BYRNE	133843560 - CRYSTAL RUN HEALTHCARE PHYSICIANS, LLP	NY	Physical Therapist (225100000X)
United	97161	$88.00	1154675932 - MOVEMENT MATTERS REHABILITATION OT, PT, SLP, PTA PLLC	800718736 - (NY) MOVEMENT MATTERS REHABILITATION	NY	Occupational Therapist (225X00000X)
United	97161	$84.00	1225874639 - BRIAN MAGEE	61655704 - (NY) SPORTS PHYSICAL THERAPY OCCUPATIONA THERAPY AND REHABILITATION SERVICE	NY	Physical Therapist (225100000X)
United	97161	$73.51	1912145780 - TZVI ZIEGLER	133595755 - (NY) EZRAS CHOILIM HEALTH CENTER INC	NY	Speech-Language Pathologist (235Z00000X)
United	97161	$88.00	1396828091 - ABSOLUTE CARE PHYSICAL THERAPY GROUP, PLLC	710898695 - (NY) ABSOLUTE CARE PHYSICAL THERAPY GROUP PLLC	NY	Physical Therapist (225100000X)
United	97161	$76.55	1033579859 - CAITLIN LEE	156000458	NY	Occupational Therapist (225X00000X)
United	97161	$88.00	1184892507 - THETHERAPYSPOTFORPEDIATRIC&ADULTSPEECHPHYSICAL&OCCUPATIONALTHERAPYPLLC	261897354 - THETHERAPYSPOTFORPEDIATRICADULTSPEECHPHYSICALOCCUPATIONALTHERAPYPLLC	NY	Physical Therapist (225100000X)
United	97161	$88.00	1649874405 - SHISHKIN PHYSICAL THERAPY REHAB PC	841861156 - (NY) SHISHKIN PHYSICAL THERAPY REHAB PC	NY	Physical Therapist (225100000X)
United	97161	$173.67	1376883181 - GABRIELLA PRESTON	141338386 - (NY) SUNNYVIEW HOSPITAL AND REHABILITATION CENTER	NY	Occupational Therapist (225X00000X)
United	97161	$84.00	1588708705 - ALYSSA ROOT	141338471 - (NY) CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER	NY	Physical Therapist (225100000X)
United	97161	$59.22	1881699304 - KAREN FURNO	113164557 - (NY) AMY ROSE PHYSICAL THERAPY PC	NY	Physical Therapist (225100000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 97161 vs. Other Physical Medicine and Rehabilitation Evaluations Codes

The CPT 97161 code is part of the Physical Medicine and Rehabilitation Therapeutic Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 97161 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
97158-CPT	Low	Adaptive Behavior Therapy, Fifteen Minutes Of Adaptive Behavior Treatment With A Physician Or Other Health Care Professional In A Group Setting. This Therapy Identifies Causes Of Stress Triggers To Anxiety And Patterns Of Response And Helps The Individual Develop New Behaviors.
97161-CPT	Low	Pt Eval Low Complex 20 Min, Physical Therapy Evaluation Low Complexity Requiring These Components A History With No Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body System S Using Standardized Tests And Measures Addressing 1 2 Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Stable And Or Uncomplicated Characteristics And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 20 Minutes Are Spent Face To Face With The Patient And Or Family
97162-CPT	Low	Pt Eval Mod Complex 30 Min, Physical Therapy Evaluation Moderate Complexity Requiring These Components A History Of Present Problem With 1 2 Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures In Addressing A Total Of 3 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions An Evolving Clinical Presentation With Changing Characteristics And Clinical Decision Making Of Moderate Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 30 Minutes Are Spent Face To Face With The Patient And Or Family

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97161. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 97161 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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